Healthcare Provider Details

I. General information

NPI: 1497037618
Provider Name (Legal Business Name): JAMIE CANO-GOMEZ MSN, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SW 36TH ST
SAN ANTONIO TX
78237-3360
US

IV. Provider business mailing address

PO BOX 87
SAN ANTONIO TX
78291-0087
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-5100
  • Fax:
Mailing address:
  • Phone: 210-358-9172
  • Fax: 210-358-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number713429
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: